Laser dermal perforator

ABSTRACT

A new laser perforator has been invented for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator in one embodiment having a laser light source for producing an output laser beam, and a mode distribution apparatus for intercepting the output laser beam to control distribution of laser energy of the output laser beam across the perforation of the skin. A laser perforator is disclosed for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator in one embodiment having a laser light source for producing an output laser beam having an energy level between about 0.1 to about 2.0 Joules, the perforation ranging in diameter between about 0.1 to about 2.0 millimeters, in depth between about 0.5 to about 4.0 millimeters, and ranging in width between about 0.05 to about 0.2 millimeters. A method is also disclosed for perforating skin for blood sampling.

RELATED APPLICATION

This is a continuation-in-part of U.S. application Ser. No. 08/297,295 filed on Aug. 29, 1994 entitled "Laser Skin Perforator" and now U.S. Pat. No. 5,554,153 issued Sep. 10, 1996.

BACKGROUND OF THE INVENTION

1. Field of The Invention

This invention relates to lasers and laser systems, and, in one aspect to a laser-device for producing a hole in skin through which blood may be withdrawn. In one particular aspect this invention relates to modifying the output profile of a laser beam to produce improved skin perforators.

2. Description or Related Art

Capillary blood sampling is a process for obtaining blood samples from the sub-dermal capillary beds of patients. A common method is to produce a small wound in the patient's skin using a sharp needle or small blade, called a blood lancet. Lancets are commonly used once and discarded. The lancet procedure produces a sharp, blood infected waste product which represents a risk to patients and healthcare workers, and which must be disposed of under carefully controlled conditions. In addition, the use of disposable blood lancets requires the healthcare providing organization to maintain a large inventory of disposable lancets. Certain lancet designs include an exposed point which produce significant fear and apprehension in patients who anticipated a painful experience. Although modern designs have attempted to eliminate such apprehension, reduction of patient discomfort would significantly increase the usefulness of new capillary sampling techniques.

Solid state lasers typically have a light source for optical excitation, an active laser material, and a set of reflecting mirrors. Most solid state lasers have a design with a rod of laser crystal or glass material optically pumped by a high intensity lamp with mirrors placed a distance from, or in contact with, or coated onto, the surfaces of the laser rod. One mirror has either a hole or a reduced reflectance relative to the other. Light is injected from the lamp or LED array into the laser material initiating the discharge of photons from dopants in the rod. These photons travel between the two mirrors producing light amplification. The amplified laser beam escapes the system through the hole or area of reduced reflectance. As an active medium one can use various lasant materials to produce different wavelengths of laser light. These materials include, but are not limited to, rare-earth-doped oxide and fluoride laser crystals and glasses, e.g. yttrium-aluminum-garnet (YAG). Such crystals and glasses will be doped with impurities to fix the resultant wavelength of the laser. These traditional laser designs have precise mirrored surfaces. The reflective surfaces are usually made by coating the surfaces with several thin layers of dielectric material. If separate mirrors are used, they are placed precisely with respect to the optical axis of the laser rod and with respect to each other. The reflective mirror surfaces can be also produced by coating them onto the polished faces of a laser crystal.

Modal distribution is a property of guided light. A projection mode can be characterized by an angular direction vector in which light beams may travel with respect to some normal angle. The normal angle is defined usually as 0 degrees with respect to the optical axis of a system. The modal distribution of a system can be characterized by a set of angular vectors in which light travels upon output from the system. A low order distribution is one in which most of the energy in a light beam travels parallel or near to parallel with the optical axis with a single centroid. Most commonly available laser devices are designed to have a low order distribution of modes; i.e., most devices are preferably designed so that light energy travels only in the TEM.sub.∞ mode (parallel and close to the normal vector with low order distribution) or within a small set of angular vectors surrounding the normal vector. A higher order distribution is one in which energy light travels at greater angles in more complex patterns with respect to the optical axis.

Prior art lasers have been used for cutting materials such as skin tissue. Such laser devices, in general, have four distinct functional stages: 1) pumping, in which the laser gain material is stimulated to produce monochromatic emission; 2) resonation, in which the stimulated emission is amplified and the fundamental radiative properties of the beam are created; 3) output conditioning, in which optical devices such as lenses and filters are used to condition the emitted light into a suitable form for transmission; and 4) delivery, in which the light energy is projected onto the target in a useful manner. Prior art biomedical lasers have one of three delivery methods: 1) contact method, in which a solid transparent light delivery means is placed in direct contact with tissue to be cut or ablated and energy is transferred to the target tissue primarily by conduction; 2) non-contact method, in which the laser beam is projected through a transparent fluid medium, such as air, and energy is transferred primarily by radiation; and 3) indirect method, wherein one of the first two methods is used to heat an additional surface which, in turn, destroys the target tissue though conduction of black-body heat.

Prior art solid-state laser devices typically include various common elements such as: a) a rod of laser gain material composed of a host material (e.g., yttrium aluminum garnet, YAG) and dopant such as Holmium, Erbium, or Neodynium; b) a pumping source which emits photons into the gain material, such as a flashlamp or laser diode; c) a resonating chamber composed of reflective mechanisms which produce a coherent standing wave within the gain material, such as reflective coatings on the ends of the gain material rod or external mirrors mounted parallel to the ends of the gain rod; d) a reflector which may surround the pump source and gain rod and which directs photons toward the gain rod; e) beam conditioning optics which modify the laser output of the resonator and direct such energy toward a delivery mechanism, or towards the work target; and d) a delivery mechanism which collects emitted laser energy and transmits it to the work target. Each of these elements may be composed of various optical components and materials.

The light emitted by most lasers contains several discrete optical frequencies which can be associated with different modes of the optical resonator. It is common practice to categorize two types of resonator modes: transverse modes and temporal modes. The beam characteristics of a laser such as divergence, diameter, and cross-sectional energy distribution are governed primarily by the transverse modes. The modal distribution of a particular laser is a critical factor in determining its suitability for a given application. In general, laser beam quality is regarded as being higher when modal distribution is kept to a low order. This provides significant advantages in energy density and precision for many applications. U.S. Pat. No. 5,352,495 to Henderson et al teaches controlling modal distribution for the treatment of surfaces by a laser. Henderson further teaches achieving higher-order modal distributions by insuring the production of a large number of modes for the purposes of, e.g., marking paper. In an example Henderson introduces the concept of a "top hat" mode distribution, a combination of a plurality of single modes.

A variety of low-order and single mode lasers have been developed and are used in medical applications such as eye surgery, general surgery, tissue necrosis, and sensor probes. Laser skin perforators for capillary blood sampling are disclosed in U.S. Pat. No. 5,165,418, in Japanese Patent 4,314,428, and in PCT patent application U.S. 93/10279. Certain lasers of the type described in these publications will typically exhibit a low order distribution of modes with radiant energy concentrated toward the center of the beam and, thus, the holes, or wounds, produced are relatively deep and penetrating with respect to the thickness of the skin. Such wounds are the shape of a champagne glass with a broad entrance wound and a longer slender stem. The Russian scientific abstract "Non-contact device for blood taking" from the Moscow-Brest conference of 1990 on lasers in medicine specifically discusses this effect. Blood is found to be available from the upper bowl portion of the wound, but little blood escapes from the lower portion, or stem, of the wound.

There has long been a need to produce capillary blood samples without the production of hazardous waste products. There has long been a need to eliminate the use of disposable implements for performing such procedures while reducing worker exposure to infectious disease. There has long been a need to reduce patient discomfort and pain associated with capillary blood collection.

SUMMARY OF THE PRESENT INVENTION

In various embodiments the present invention discloses certain mechanisms used to insure that laser devices used for skin perforation and capillary blood sampling exhibit a high order mode distribution which improves the performance of such perforator devices. These mechanisms are effected by manipulation of beam conditioning optics and of the resonator of solid-state lasers.

The present invention provides evenly distributed laser energy across a wound site, producing a more closely regulated wound with respect to diameter and depth. Obtaining access to capillary blood with this system provides a less painful sensation to the patient and better control of the wound profile with respect to previously disclosed laser-based skin perforators. Evenly distributed energy across a greater set of modal vectors produces a more controlled wound profile. In certain embodiments of the present invention, control over the mode distribution of a laser beam is achieved by the following: a) optimization of the geometry of laser resonator geometry; b) use of external spatial filters; or c) use of optical fibers and waveguides. Projecting a laser beam with high mode distribution on skin according to the present invention produces an upper wound profile with a relatively broad bowl portion without production of the lower, less useful, portion of a wound. Such laser perforator systems also produce less pain among subjects. Incorporation of mode distribution allows greater control of a wound profile and collection of blood, while producing less pain in subjects. Any suitable laser may be used according to the present invention; including, but not limited to, solid-state lasers, gas lasers, dye lasers, diode lasers, and diode-pumped solid-state lasers. In one aspect the output laser beam has an energy level ranging between about 0.1 to about 2 Joules and in one particular aspect the energy level is about 1 Joule. In certain aspects a pulsed laser beam is used with a pulse width ranging between 50 and 500 microseconds.

According to certain embodiments of the present invention, a laser perforator system is designed to control the mode distribution of an output laser beam or has apparatus for the mode distribution of a laser beam, including but not limited to, a hollow waveguide, a solid optical fiber waveguide, spatial filters, specific laser active element geometries, and specific laser active element materials.

Laser light projected into the interior of a hollow waveguide (such as a capillary tube, miniature metal tube, or optical fiber) is reflected from the walls of the waveguide producing a modal distribution which expands along the length of the waveguide. Thus, optical fiber waveguides generate expanded modal distributions of light beams. Optical fibers are designed so that light reflecting from the walls is effectively retained within the fiber. It is possible to guide light through the fiber in such a way as to generate higher order modes. Bends in the optical fiber may be used to generate or reject specific portions of the modal distribution, especially higher order modes, allowing control of the output distribution.

Spatial filters reduce the amount of energy traveling in particular cross sectional areas of a laser beam. Usually, low order modes are reduced by filtering the center of the beam. The use of spatial filtering, however, reduces the overall energy of a beam, reducing the energy efficiency of a system.

It is common knowledge that one design feature of laser devices is the modal distribution of the output beam. In many cases of laser design the designer tries to produce a very low order distribution of modes, including designs of value in other fields which produce a single mode output. It is not obvious that one should reverse the objectives of common laser design practices in order to produce a more useful laser perforator.

Modal distribution of laser output may be manipulated by changes in the geometry of the laser active element. For example the laser element described in U.S. patent application Ser. No. 08/204,560, entitled "Laser Rod With Polyhedron Shaped Ends," now U.S. Pat. No. 5,432,811 issued Jul. 11, 1995, filed on Mar. 1, 1994 and now U.S. Pat. No. 5,432,811 and co-owned with the present invention (incorporated herein by reference for all purposes) describes a solid state laser crystal geometry which produces an output with a relatively higher order multi-mode distribution. In general, the inclusion of reflective surfaces into the laser cavity which are not orthogonal to the optical axis of the laser system design, will produce increased order of modal distribution.

It has been found that certain laser materials naturally produce higher order mode distribution. For example, a laser constructed with erbium-doped Yttrium Scandium Aluminum Garnet (YSAG) active element has a higher order distribution than the same laser built with erbium-doped YAG (YAG:Er).

In certain embodiments the present invention discloses devices as discussed above with apparatus for producing a laser output beam with a ring profile yet still preserving multimodal distribution rather than single mode.; in one aspect a hollow cylindrical rod accomplishes this. A system according to this invention includes such apparatus and a laser light source.

In an optical resonator electromagnetic fields can exist whose distribution of amplitudes and phases reproduce themselves upon repeated reflections. These field configurations comprise the transverse electromagnetic modes (TEM) of a passive resonator. Transverse modes are defined by the designation TEM_(mn) for Cartesian coordinates. The integers m and n represent the number of nodes or zeros of intensity transverse to the beam axis in the vertical and horizontal directions. The higher the numbers m and n, the higher the mode order of the beam.

A high order mode distribution for an output beam for certain embodiments of the present invention is defined as any mode distribution characterized with the sum of m and n equal to an integer greater than 0. A high order distribution is, for example, TEM₁₁ which resembles the pattern seen with a tetragonal shaped multi-faceted crystal resonator, e.g., see U.S. Pat. No. 5,432,811 co-owned with this invention. (The emission from faceted crystals is actually a combination of modal patterns.) In certain embodiments the mode distributions are characterized by m and n such that the sum of m and n is greater than 1; and, in other embodiments the mode distribution is characterized by a summation of a plurality of modes each characterized by TEM_(mn), where m+n is greater than 0 for each mode.

A ring shaped beam may be created by a resonator operating in single mode (low order) of TEM₀₁, but, in certain embodiments of the present invention beam shaping for rings and polyhedrons is achieved by shaping a multimode (high order) beam with physical optics, not generated solely by an interface pattern.

In one aspect the present invention discloses a laser perforator for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator having a laser light source for producing an output laser beam, and mode distribution apparatus for intercepting the output laser beam to control distribution of laser energy of the output laser beam across the perforation of the skin. In another aspect such a laser perforator has a laser light source for producing an output laser beam having an energy level between about 0.1 to about 2.0 Joules, a mode distribution apparatus for controlling mode distribution of the output laser beam across the perforation of the skin, the mode distribution apparatus including a cylindrical laser rod to produce ring shaped distribution of the output laser beam, the cylindrical laser rod having a 90 degree annular corner reflector to produce a ring shaped distribution of the output laser beam, a doughnut lens for focusing the output laser beam, with the perforation ranging in diameter between about 0.1 to about 2.0 millimeters, in depth between about 0.5 to about 4.0 millimeters, and ranging in width between about 0.05 to about 0.2 millimeters. The present invention teaches a method for perforating skin for blood sampling to produce a perforation to permit blood under a surface of the skin to flow out, the method including producing a laser beam from a laser, the beam having an energy level and a plurality of energy modes, distributing the energy modes of the beam by mode distribution apparatus for evenly distributing the energy modes, producing an output beam with an evenly distributed mode distribution, and directing the output beam to the skin and producing a perforation through the skin through which the blood flows. In another embodiment the present invention discloses a laser perforator for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator having a laser light source for producing an output laser beam, and a mode distribution apparatus for producing a ring shaped profile of the output laser beam. In one such perforator the ring has a diameter ranging between about 0.1 to about 2.0 millimeters and a circular slit perforation is produced ranging in depth between about 0.5 to about 4.0 millimeters and ranging in width between about 0.05 to about 0.2 millimeters.

The present invention discloses, in certain embodiments, a laser device for perforating skin to permit blood under the surface of the skin to flow out, the device having a pulsed solid-state laser light source with a pumping apparatus, a resonator with a resonator chamber and including a solid segment of a laser gain material, output optics for producing a laser beam having a cross sectional shape, and mode distribution apparatus incorporated into the resonator chamber or output optics for producing high-order multimode operation of the laser light source; such a device wherein the mode distribution apparatus is incorporated into resonator and includes multi-faceted polyhedral ends as an integral part of the solid gain material, and with the ends producing internal reflection and resonation of stimulated emission; such a device wherein the mode distribution apparatus is incorporated into the resonator and includes solid conical ends as an integral part of the solid gain material, and with the conical ends producing internal reflection and resonation of stimulated emission; such a device wherein the cross sectional shape of the multimode laser beam is in the shape of a ring; such a device wherein the mode distribution means is incorporated into the resonator and comprises a hollow tubular rod of the gain material and further includes a right angular annular corner reflector at the ends of the tubular rod, and with said right angular corner reflector ends producing internal reflection and resonation of stimulated emission parts; such a device wherein the mode distribution means is incorporated into the resonator and has a solid rod of the gain material and further includes a right angular annular corner reflector at the ends of the tubular rod, and with the right angular corner reflector ends producing internal reflection and resonation of stimulated emission; such a device wherein the resulting perforation in the skin is ring shaped and has a diameter ranging between about 0.1 and 2 millimeters, a depth ranging between about 0.5 and 4 millimeters, and an annular width ranging between about 0.05 and 0.2 millimeters; such a device wherein a doughnut shaped lens is used to focus the multimodal laser light onto the skin in a ring shaped pattern; such a device wherein the mode distribution means is incorporated into the output optics and is includes a short segment of a hollow waveguide suitable for conducting and mode-mixing the laser beam energy; such a device wherein the short segment of hollow waveguide is between about 5 millimeters and about 25 millimeters in length; such a device wherein the mode distribution means is incorporated into the output optics and has a short segment of optic fiber suitable for conducting and mode-mixing the laser beam energy such a device wherein the short segment of optic fiber is between about 5 millimeters and about 25 millimeters in length; such a device wherein the energy level of the output laser beam ranges between about 0.1 to about 2 Joules incident on the skin; such a device wherein the resulting perforation of the skin ranges in diameter between about 0.1 and about 2 millimeters and the resulting perforation in the skin ranges in depth from about 0.5 to 4 millimeters; such a device wherein the said pulsed laser light source has a pulse duration time constant ranging from about 50 to about 500 microseconds; such a device for perforating the skin to permit blood under the surface of the skin to flow out wherein the shape of the beam produced by the laser device has a ring shape and the beam makes a wound in the skin in the shape of a ring; such a laser device for perforating the skin to permit blood under the surface of the skin to flow out wherein the shape of the beam produced by the laser device has a polygonal shape and the beam makes a wound in the skin in the shape of a straight-sided polygon (e.g. but not limited to a triangle, quadrangle, pentagon, hexagon, etc.). The present invention, in certain embodiments, discloses a laser perforator for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator having a laser light source for producing an output laser beam, and mode distribution means for producing an output laser beam with multi-mode distribution, the mode distribution means for controlling projection of laser energy across the perforation of the skin and for providing evenly distributed laser energy across the perforation, wherein the perforation's depth is not more than two millimeters; such a perforator wherein the mode distribution means produces a ring-shaped output laser beam; such a perforator wherein the laser light source has an energy level wherein the energy level of the output laser beam ranges between about 0.1 to about 2.0 Joules incident on the skin; such a perforator wherein the perforation ranges in diameter between about 0.1 to about 2.0 millimeters; such a perforator wherein the perforation ranges in depth between about 0.5 to about 4.0 millimeters; such a perforator with a doughnut lens for focusing the output laser beam onto the skin in a ring shaped pattern; such a perforator wherein the ring-shaped output laser beam has a diameter ranging between about 0.1 to about 2.0 millimeters and a circular slit perforation is produced ranging in depth between about 0.5 to about 4.0 millimeters and ranging in annular width between about 0.05 to about 0.2 millimeters; such a perforator wherein the mode distribution means is a hollow tube with a laser-energy-reflective interior; such a perforator wherein the mode distribution means is an optical fiber waveguide; such a perforator wherein the output laser beam is pulsed at between 50 and 500 microseconds; such a perforator wherein the mode distribution means has a body with multi-faceted polyhedral ends producing internal reflection of the output laser beam; such a perforator wherein the mode distribution means has a body with a solid conical end producing internal reflection of the output laser beam; such a perforator wherein the mode distribution means has a body comprising a hollow tubular rod with two ends and a right angular annular corner reflector at each of the ends, and the right angular corner reflector ends producing internal reflection of the output laser beam; such a perforator wherein the mode distribution means has a body comprising a solid rod with two ends and a right angular annular corner reflector at each of the ends, and the right angular corner reflector ends producing internal reflection of the output laser beam.

The present invention recognizes and addresses the previously mentioned problems and long-felt needs and provides a solution to those problems and a satisfactory meeting of those needs in its various possible embodiments and equivalents thereof. To one of skill in this art who has the benefits of this invention's realizations, teachings, disclosures, and suggestions, other purposes and advantages will be appreciated from the following description of preferred embodiments, given for the purpose of disclosure, when taken in conjunction with the accompanying drawings. The detail in these descriptions is not intended to thwart this patent's object to claim this invention no matter how others may later disguise it by variations in form or additions of further improvements.

A more particular description of embodiments of the invention briefly summarized above may be had by references to the embodiments which are shown in the drawings which form a part of this specification. These drawings illustrate certain preferred embodiments and are not to be used to improperly limit the scope of the invention which may have other equally effective or legally equivalent embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a graph demonstrating low order mode distribution for a prior art laser perforator. FIG. 1B is a schematic representation of a dermal wound produced by a laser with a mode distribution as in FIG. 1A.

FIG. 2A is a graph of high order mode distribution for a laser according to the present invention and FIG. 2B shows schematically a dermal wound produced by such a laser.

FIG. 3A is a schematic view of a laser-based skin perforation system according to the present invention. FIG. 3B is a detail view of the wound-site produced by the perforator system of FIG. 3A. FIG. 3C shows the modal distributions at plane A--A of FIG. 3A. FIG. 3D shows the modal distribution at plane B--B of FIG. 3A.

FIG. 4A is a side schematic view of a mode distributor for use according to the present invention. FIG. 4B is a side schematic view of a mode distributor for use according to the present invention. FIG. 4C is a side schematic view of a mode distributor for use according to the present invention.

FIG. 5A is a side view of a laser active element for use according to the present invention. FIG. 5B is a side view of a laser active element for use according to the present invention.

FIG. 6A is a graph of a ring-shaped beam mode distribution for a laser system according to the present invention. FIG. 6B shows schematically a lateral view of a dermal wound produced by such a laser system. FIG. 6C shows a top-view of the ring shaped wound produced by such a laser system.

FIG. 7A shows the optical system to produce a laser beam with ring mode distribution according to the present invention. FIG. 7B and 7C show graphs of laser beam energy distribution across axes B--B and C--C of FIG. 7A.

FIG. 8A is a side view of a laser active element for use according to the present invention. FIG. 8B is an end view of the element of FIG. 8A. FIG. 8C is a schematic representation of the element of FIG. 8A showing the paths of laser light rays. FIG. 8D shows the cross-sectional ring shape of the laser output beam. FIG. 8E is a perspective view of the element of FIG. 8A.

FIG. 9A is a schematic view showing use of a doughnut lens according to present invention. FIG. 9B is a top view of the wound shown in FIG. 9A.

FIG. 10A is a schematic of a system according to the present invention. FIG. 10B is a graph of the mode distribution of the beam energy levels of the beam of the device of FIG. A along axis of B--B of FIG. 10A. FIG. 10C is a graph of the mode distribution of the beam along axis C--C of FIG. 10A.

DESCRIPTION OF EMBODIMENTS PREFERRED AT THE TIME OF FILING FOR THIS PATENT

Referring to FIG. 1, FIG. 1A shows a graphical representation of a beam profile such as commonly available from laser system designs which do not employ the use of a mode distribution mechanism, as described in the prior art. The vertical axis shows the normalized intensity of the laser and the horizontal axis indicates location in the beam with respect to the axial optical center of the beam ("O"). FIG. 1B shows a schematic representation of the lateral view of holes produced in skin by such lasers as determined by experiments conducted under the direction of the inventors. Normalized intensity shows the relationship of beam intensity versus distance from the beam's axial optical center (O) in arbitrary units. A maximum value for intensity versus distance is 1.

FIG. 2A shows a representation of a beam profile achieved when using a mode distribution mechanism according to the present invention. Again the vertical axis shows normalized intensity. FIG. 2A shows a representation of the lateral cross section of holes in skin obtained when using such a system. The lower portion "stem" portion of the hole is noticeably missing. In addition the relatively broad profile of the hole intersects a greater number of subdermal capillaries, producing more blood availability from wounds of this type, while minimizing the volume of tissue ablated and the sensation of pain to the subject.

Referring now to FIG. 3A, a system 10 according to the present invention has a light generator 12 (e.g. a solid state laser based on YAG:Er, or GGG:Er, or YAP:Er, or other laser with fundamental output wavelength suitable for perforating the skin) and a mode distribution apparatus 14 e.g. but not limited to a hollow waveguide; a solid optical fiber; or a spatial filter! which produce a laser light beam L which is focused by lens 16 onto a finger F of a patient to produce a hole H which perforates the sub-dermal capillary bed of the finger and through which the patient's blood may flow for exterior collection.

FIG. 3B shows a schematic representation of a wound in skin produced with the system of FIG. 3A. FIG. 3C shows a representation of the beam distribution profile before the mode distributor at plane A--A of FIG. 3A and FIG. 3D shows the distribution after the mode distributor at plane B--B of FIG. 3A. The vertical axes in FIGS. 3C and 3D are normalized intensity and the horizontal axis represents the optical axis of the beam (center at O).

FIG. 4A shows a mode distributor as an optical fiber 20 with a core 22 and cladding 24. FIG. 4B shows a mode distributor as a light waveguide 30. FIG. 4C shows a mode distributor as a spatial filter 40. In each case multiple reflections of the laser beam (indicated by arrow) incident to the mode distributor result in a higher order mode distribution at the output of the mode distribution mechanism. (Inputs shown on left, outputs to the right in the FIGS.)

In certain embodiments the light generator 12 includes an active laser element (e.g. but not limited to those described in U.S. application Ser. No. 08/204,560) now U.S. Pat. No. 5,554,153 issued Sep. 10, 1996 as the element T shown in FIG. 5A. Also, angular reflection surfaces (e.g. as described in but not limited to those of U.S. application Ser. No. 08/204,560) as the element N shown in FIG. 5B may be used in the light generator 12 to increase the modal distribution of the output beam (arrows indicate light paths and reflected light paths).

FIG. 6A illustrates a mode distribution for a laser beam produced with apparatus according to the present invention as shown in FIG. 7A. A hole H in skin S produced by such a beam is shown in FIGS. 6B and 6C. In such an embodiment the modal distribution has a "ring" shape of the output beam so that a circular slit (hole H) is produced in the skin rather than a hole as produced by previously described embodiments. Such slits have been found to be less painful than wider holes. In one particular embodiment a circular slit about 0.05 millimeters wide ("w" in FIG. 6B) is produced with a diameter ("d") of about 0.75 mm, a depth ("p") of about 2 mm, and an outer circumference of about 2.4 mm by a YAG:Er laser operated at about a 1 Joule energy level for about 200 microseconds.

It is within the scope of this invention to provide mode distribution apparatus to produce a ring shaped output beam. FIG. 7A illustrates a solid state laser system 60 for producing a laser beam with "ring" shape according to the present invention. The system 60 has a hollow cylindrical body 64 made, e.g., from YAG:Er, YAP:Er, GGG:Er, YSAG:Er etc. with a central longitudinal channel 66 along its length. Light reflected by a back mirror 68 and a partially reflective mirror 72 is amplified in a hollow cylindrical active laser element 62 producing a "ring" shape laser beam. FIG. 7B is a graph of laser beam energy distribution at axis B--B of FIG. 7A; and FIG. 7C is a graph of laser beam energy distribution at axis C--C of FIG. 7A. "O" in each figure indicates the device' central optical axis.

It is within the scope of this invention that the laser beam energy distribution output profile be asymmetrical with respect to the optical axis of the device and that the energy mode distributions not be identical. FIGS. 8A and 9A show different active elements 70 and 74, respectively, for achieving a high order multi-mode laser beam with a ring shape. Each active element 70 or 80 is not a hollow cylinder but a cylindrical element where one face is made with a cone C which forms a 90 degree reflector (see FIG. 9A) within which a further conical surface F has been ground with an apex diametrically opposed to the cone C such that the two conical surfaces form the circular reflective surface at that end of the element. This reflective surface can also be described as the upper surface of a solid which would be generated by the 360 degree rotation of a right triangle having two equal sides

FIG. 8A and 8C show an active element 70 for achieving a laser beam with a "ring" shape. The active element 70 is not a hollow cylinder but a cylindrical element with one face made with a cone C which forms a 90 degree reflector (see FIG. 8C) within which a further conical surface F has been ground with an apex diametrically opposed to the cone C such that the conical surface forms the circular reflective surface at that end of the element. The resulting reflective surface can also be described as the upper surface of a solid which would be generated by the 360 degree rotation of a right triangle having two equal sides with the bottom side being less in length or equal to the radius of the laser rod. This annular 90 degree reflector plays a two-fold role: 1) it works like a back mirror, and 2) it determines the back boundary of the resonation cavity of the laser rod. In this design the central part of the rod R is not used to produce a laser beam. Only cylindrical layer limited by the annular corner reflectors produces a laser beam, a beam with a ring shape.

The lens 74 (FIG. 7A, 9A) is used to focus laser beam with the ring shape to decrease the diameter and the thickness of the ring slit in order to make a circular cut in a patient's finger. The lens 74 has a doughnut shape. The diameter d of the lens 74 is determined by the diameter R of the ring shape laser beam (see FIG. 9A). The focal distance f of the lens 74 is chosen preferably to achieve a desired diameter m for the circle slit S on the skin. (See also FIG. 9B.)

Lasers emitting a ring shaped beam may also be used with mode distributions mechanisms as described above to further control the laser system output profile.

FIG. 10A shows another system according to the present invention for producing a ring-shaped laser output profile. In this system a laser rod 75 produces an output beam 76 which is directed toward a mirror 77. The mirror 77 has a hole 78 in it which is preferably centered slightly off the optical axis of the laser system. In this case light impinging on the hole is selected for high-order modes. The output profile of the beam passing through the hole has a ring-shaped profile and produces a ring-shaped wound in skin. FIG. 10B shows the beam's mode at axis B--B of FIG. 10A and FIG. 10C shows the beam's mode distribution at the axis C--C of FIG. 10A. It is within the scope of this invention to provide a hole in the mirror not on the optical axis of the invention at any desired distance from the optical axis.

Pending application Ser. No. 08/297,295 and U.S. Pat. No. 5,432,811, both co-owned with the present invention, are incorporated fully herein by reference for all purposes.

In certain preferred embodiments of each of the previously described systems and lasers, the laser output beam is pulsed, preferably with a pulse width between 50 and 500 microseconds.

In conclusion, therefore, it is seen that the present invention and the embodiments disclosed herein and those covered by the appended claims are well adapted to carry out the objectives and obtain the ends set forth. Certain changes can be made in the subject matter without departing from the spirit and the scope of this invention. It is realized that changes are possible within the scope of this invention and it is further intended that each element or step recited in any of the following claims is to be understood as referring to all equivalent elements or steps. The following claims are intended to cover the Invention as broadly as legally possible in whatever form it may be utilized. 

What is claimed is:
 1. A laser perforator for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator comprisinga laser light source for producing an output laser beam, and a mode distribution means for intercepting the output laser beam to control distribution of laser energy of the output laser beam across the skin, the mode distribution means for producing a multi-mode output laser beam.
 2. The laser perforator of claim 1 further comprisingbeam shaping means for producing ring shaped distribution of the output laser beam.
 3. The laser perforator of claim 2 further comprising a doughnut lens for focusing the output laser beam.
 4. The laser perforator of claim 2 wherein the ring has a diameter ranging between about 0.1 to about 2.0 millimeters and a slit perforation is produced ranging in depth between about 0.5 to about 4.0 millimeters and ranging in width between about 0.05 to about 0.2 millimeters.
 5. The laser perforator of claim 1 wherein the mode distribution means is a cylindrical laser rod.
 6. The laser perforator of claim 5 wherein the cylindrical laser rod has a 90 degree annular corner reflector to produce a ring shaped distribution of the output laser beam.
 7. The laser perforator of claim 1 wherein the energy level of the output laser beam ranges between about 0.1 to about 2.0 Joules incident on the skin.
 8. The laser perforator of claim 1 wherein the perforation ranges in diameter between about 0.1 to about 2.0 millimeters and the perforation ranges in depth between about 0.5 to about 4.0 millimeters.
 9. The laser perforator of claim 1 wherein the output laser beam has an energy level of about 1.0 Joules.
 10. The laser perforator of claim 1 wherein the mode distribution means is a spatial filter.
 11. The laser perforator of claim 1 wherein the mode distribution means is a hollow tube with a laser-energy-reflective interior.
 12. The laser perforator of claim 1 wherein the mode distribution means is an optical fiber waveguide.
 13. The laser perforator of claim 12 wherein the output laser beam is pulsed at between 50 and 500 microseconds.
 14. The laser perforator of claim 1 wherein the output laser beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than zero.
 15. The laser perforator of claim 1 wherein the output laser beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than
 1. 16. A laser perforator for perforating skin with a perforation to permit blood under a surface of the skin to flow out, the perforator comprisinga laser light source for producing an output laser beam having an energy level wherein the energy level of the output laser beam ranges between about 0.1 to about 2.0 Joules incident on the skin, and the laser light source having mode distribution means for producing an output laser beam with multi-mode distribution, the mode distribution means for controlling projection of laser energy across the perforation of the skin and for providing evenly distributed laser energy across the perforation, wherein the perforation ranges in diameter between about 0.1 to about 2.0 millimeters and the perforation ranges in depth between about 0.5 to about 4.0 millimeters.
 17. A laser device for perforating skin to permit blood under a surface of the skin to flow out, the laser device comprisinga pulsed solid-state laser light source havingsolid state laser gain material, pumping apparatus for producing a monochromatic light beam within the solid state laser gain material, resonator apparatus including a solid segment of a laser gain material for amplifying the monochromatic light beam, output apparatus for effecting a desired cross sectional shape of the monochromatic light beam, and mode distribution apparatus for producing multi-mode output beam.
 18. The laser device of claim 17 wherein the mode distribution apparatus is the resonator and the solid segment of laser gain material has two spaced-apart multi-faceted polyhedral ends for facilitating internal reflection and resonation of the monochromatic light beam in the resonator.
 19. The laser device of claim 18 wherein the multi-faceted polyhedral ends each have at least two facets.
 20. The laser device of claim 17 wherein said mode distribution apparatus is in the resonator and the laser gain material has two spaced-apart conical ends for facilitating internal reflection and resonation of the monochromatic light beam in the resonator.
 21. The laser device of claim 17 wherein the cross sectional shape of the monochromatic light beam is in shape of a ring.
 22. The laser device of claim 21 wherein the laser gain material is a hollow tubular rod including a right angular annular corner reflector at each of two spaced-apart ends of the tubular rod, the right angular corner reflectors facilitating internal reflection and resonation of the monochromatic light beam.
 23. The laser device of claim 21 wherein the laser gain material is a solid rod with a right angular annular corner reflector at each of two spaced-apart ends of the tubular rod, the right angular corner reflector ends facilitating internal reflection resonation of the monochromatic light beam.
 24. The laser device of claim 17 wherein a resulting perforation in the skin is ring shaped and has a diameter ranging between about 0.1 and 2 millimeters, a depth ranging between about 0.5 and 4 millimeters, and a thickness ranging between about 0.05 and 0.2 millimeters.
 25. The laser device of claim 17 further comprising a doughnut shaped lens to focus a multimodal laser light output beam onto the skin in a ring shaped pattern.
 26. The laser device of claim 17 wherein the mode distribution apparatus is in the output conditioning apparatus and includes a segment of a hollow waveguide for conducting and modemixing energy of the monochromatic light beam.
 27. The laser device of claim 26 wherein the segment of hollow waveguide is between about 5 millimeters and about 25 millimeters in length.
 28. The laser device of claim 17 wherein the mode distribution apparatus is the output conditioning apparatus and is a segment of optic fiber for conducting and mode-mixing the energy of the monochromatic light beam.
 29. The laser device of claim 28 wherein the segment of optic fiber is between about 5 millimeters and about 25 millimeters in length.
 30. The laser device of claim 17 wherein an energy level of the output beam ranges between about 0.1 to about 2 Joules incident on the skin.
 31. The laser device of claim 17 wherein a resulting perforation of the skin ranges in diameter between about 0.1 and about 2 millimeters and the resulting perforation ranges in depth in the skin from about 0.5 to 4 millimeters.
 32. The laser device of claim 17 wherein the pulsed solidstate laser light source has a pulse duration time constant ranging from about 50 to about 500 microseconds.
 33. The laser device of claim 17 wherein the cross-sectional shape of the monochromatic light beam output from the laser device is a straight-sided polygon.
 34. The laser perforator of claim 17 wherein the output laser beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than zero.
 35. The laser perforator of claim 17 wherein the output laser beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than
 1. 36. A method for perforating skin for blood sampling to produce a perforation to permit blood under a surface of the skin to flow out, the method comprisingproducing a laser beam from a laser, the beam having an energy level and a plurality of energy modes, distributing the energy modes of the beam by mode distribution means for producing a multi-mode output beam, and directing the multi-mode output beam to the skin and producing a perforation through the skin through which the blood flows.
 37. The method of claim 36 wherein the energy level of the laser beam ranges between 0.1 to 2.0 Joules.
 38. The method of claim 36 wherein the perforation has a depth in the skin and the depth ranges between 0.5 to 4.0 millimeters and the perforation is circular as viewed from above the skin and has a diameter ranging between 0.1 to 2.0 millimeters.
 39. The method of claim 36 further comprisingfocusing the output beam onto the skin with a doughnut lens.
 40. The method of claim 36 wherein the multi-mode output beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than zero.
 41. The method of claim 36 wherein the multi-mode output beam has a plurality of transverse electromagnetic modes each defined as TEM_(mn) where m+n is greater than
 1. 